Rising to the Challenge of Treating OEF/OIF Veterans with Co‐occurring PTSD and Substance Abuse

This article reviews data on the relatively high incidence of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans reporting mental health and substance abuse problems, and some perceived barriers that may account for low rates of their engaging in treatment. Treatment outcomes for veterans with co‐occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) are generally poorer than for those with PTSD or substance abuse alone. Several evidence‐based individual therapy approaches offered by VA Medical Centers are described along with how they conceptualize the relationship of substance abuse to PTSD. Problems with sequential treatment for persons with PTSD and substance abuse in specialized programs are discussed, including notably the practice of requiring veterans to be completely drug and alcohol free for a month or longer prior to entering PTSD treatment. Several integrated treatment programs are described along with a brief summary of evidence supporting their effectiveness. Some recent policy changes from the Department of Veterans Affairs that bode well for the future of PTSD/SUD treatment are described. Differences between younger and older veterans were cited along with their implications for treatment. Recommendations regarding how to better engage and retain OEF/OIF veterans with PTSD/SUD in treatment are presented together with examples of their implementation. The author concludes that to rise to the challenge of treating this difficult population it is necessary to adapt treatment to meet their needs rather than requiring them to adapt to therapies that may not be a good fit.     

Perceptions of Students about Younger and Older Men and Women who May Be Homeless

ABSTRACT

Future human service providers will interact with homeless persons in health, mental health, and social service practice contexts. This study investigated the perceptions of students enrolled in social work courses who are pursuing degrees in human service programs toward older and younger female and male homeless individuals. Respondents (N = 207) were given one of four vignettes in which a character was identified as an older male, a younger male, an older female, or a younger female who was frequently seen near an interstate highway, talking to him/herself and appearing unkempt, thin, and frail. Most respondents perceived the vignette character as mentally ill, neglectful of health, likely to have HIV, tuberculosis, hepatitis A and/or hepatitis B and/or hepatitis C, likely to experience suicidal thoughts/ideation, and to have head lice/scabies/body lice. Older men were more likely to be perceived as military veterans with a history of mental illness and substance abuse. Older women were least likely to be perceived as having a history of substance abuse or using a handout to purchase ethanol. Older women were perceived to be homeless because they could not afford other living accommodations. A general linear model revealed significant differences in 7 of 41 items that respondents answered based on the gender and age of the vignette characters. These perceptual differences between male and female homeless persons will require additional investigation.     

“I screamed but then realized nobody was listening”: Exploration of the presence of others during intrafamilial child sexual abuse through survivors' testimonies from the Israeli Independent Public Inquiry

Intrafamilial child sexual abuse (IFCSA) is perceived as a crime perpetrated without witnesses. Nevertheless, researchers have explored two main aspects of the others present during abusive incidents: bystanders in extra-familial child sexual abuse and bystanders' decisions of whether to become involved. However, there is a lack of knowledge regarding how children and survivors perceive and experience the presence of others during abusive incidents. The current study examined survivors' experiences and perceptions concerning the presence of others during IFCSA based on their written testimonies for an independent inquiry. Of the more than 500 written testimonies sent to an independent Israeli inquiry, 16 addressed IFCSA and the others present. Inductive thematic analysis was conducted, and four main themes were identified: survivors' perceptions of others, others' responses to the abuse, familial dynamics with others during abuse, and acceptance. The discussion addresses the phenomenon of the presence of others during IFCSA and related theories of trauma and family dynamics. The findings challenge the social perception of IFCSA as a secret, highlighting the awareness that characterizes it in reality, as illustrated in the survivors' testimonies. This emphasizes the urgent need for policy-makers and professionals to promote the publicness of IFCSA instead of maintaining its secrecy.     

POWER AND ADDICTION: THE MAKING OF THE MODERN ADDICT

This article provides a genealogical analysis of the ‘discovery’ of the modern phenomenon of addiction. It considers how the emergence of a bio-politics of the population in the industrialising West facilitated the invention of addiction and supported an argument for the regulation of opiate use. As a result of regulation, particular patterns of opiate use became increasingly visible. In response the medical profession, in the late nineteenth century, through the use of power-knowledge strategies transformed opiate use from a diverse set of social valuations to a unified pathology associated with madness, or unreason. This constitution of addiction as a negative category has been developed and appropriated by other discourses to provide the foundation for disciplinary interventions directed towards the regulation of undesirable patterns of consumption.     

The relationship between perceived parental physical availability and child sexual,physical and emotional abuse among high school students in the Northern Province,South Africa

This is an investigation into the relationship between perceived parental physical availability and child sexual, physical and emotional abuse among high school students in the Northern Province (South Africa). All the secondary school students in standards 9 and 10 in three secondary schools filled in a retrospective self-rating questionnaire in a classroom setting. The questionnaire asked questions about perceived parental physical availability during childhood, and childhood sexual, physical and emotional abuse. Logistic Regression Analysis shows that among all the participants, “haven ever had a stepfather or adoptive father until he or she was at least 16 years old” and again, “haven ever had a stepfather or adoptive father until he or she was at least 16 years old” and “haven lived in a ‘group home’ until he or she was at least 16 years”; and “haven been raised by any other adult” predict child sexual, physical and emotional abuse, respectively. Mental health and social workers, educators and law enforcement agencies dealing with prevention and protection against child abuse in the Province should take note of the above identified predictors while designing programmes for the eradication of child sexual, physical and emotional abuse.     

Adolescent‐to‐parent violence and abuse: Parents' management of tension and ambiguity—an interpretative phenomenological analysis

Adolescent violence and abuse towards parents is under researched, especially in the UK where reports of the phenomenon are increasing with little clear guidance as to how practitioners might respond. In this qualitative study, 6 parents were recruited through youth offending teams and were interviewed about their lived experiences of violence and/or abuse from their adolescent child. Using interpretative phenomenological analysis, 3 superordinate themes emerged (a) the tensions and (b) the ambiguities produced by living with the violence and abuse and (c) the ways that parents manage the harms caused by these tensions and ambiguities. Theoretical and clinical implications are discussed, including consideration of how practitioners might support parents who are living with adolescent‐to‐parent violence and abuse to establish healthy and sustainable coping strategies while repairing family relationships.     

The Substance Abuse Treatment Self-Efficacy Scale

Abstract

Evaluating substance abuse services in ordinary treatment environments requires the use of instruments to measure various dimensions of the intervention process in order to link those processes with client outcomes. This paper reports on the further validation of the Alcohol and other Drug Self-Efficacy Scale (AODSES), designed to measure social workers' perceived self-efficacy with regard to the implementation of substance abuse services. In the first validation study, Kranz (2003) employed exploratory factor analysis to reduce the original 98 items to six factors (43 items) that accounted for 76% of the variance, and demonstrated excellent internal consistency. The current study is a reanalysis of the same data using confirmatory factor analysis, a more stringent test of construct validity. Results were strongly supportive of a 5-factor model with seven of eight indices showing excellent fit of the observed data to the model, and high internal consistency for all subscales. Potential practical applications for clinical evaluation in substance abuse environments and limitations of the study are discussed.     

SOURCES OF INFORMATION ABOUT HIV/AIDS AND PERCEIVED RISK OF INFECTION AMONG HETEROSEXUAL YOUNG ADULTS: 1989 AND 1994

This paper reports a study of sources of information about HIV/AIDS and trust of the sources among heterosexuals in 1989 (113 females and 91 males) and 1994 (185 females and 66 males). We also examined whether perceived personal risk of HIV infection was predicted by sources of information about HIV/AIDS, trust of the sources, how informed about AIDS people believed they were, and perceived risk of infection to others, as well as whether there was a relationship between perceived personal risk and safe sex behaviour. Participants received most of their information about AIDS/HIV from magazines, newspapers, and television, but placed most trust on sources such as doctors and HIV/AIDS organisations. Perceived personal risk was influenced most by perceived risk to friends and to people with the same sexual practices. In the 1994 sample, perceived personal risk was correlated with the amount of condom use among participants with sexual experience. These results indicate ther has been relative stability across a five-year period. They also point to the continuing discrepancy among young heterosexuals between the most-used and most-trusted sources of information, as well as to the importance of peer influence on perceptions of personal risk of HIV infection.     

On the significance of social control: Treatment‐entry pressures,self‐choice and alcohol and drug dependence criteria one year after treatment

Storbjörk J. On the significance of social control: treatment‐entry pressures, self‐choice and alcohol and drug dependence criteria one year after treatment This article explores how self‐choice and treatment‐entry pressures are associated with one‐year treatment outcome (dependence symptoms, 0–6, 12 months) among alcohol and drug misusers, respectively. Informal pressures (from family and friends), formal pressures (related to work, healthcare, social services, social allowances, child custody) and legal pressures (related to the police, criminal justice system, compulsory treatment) were analysed. A sample (N= 1,210) representative of the addiction treatment system of Stockholm County was interviewed when starting a new treatment episode and after one year. Regression analyses indicated that self‐choice and pressures are associated with outcome among alcohol misusers but not among drug misusers when controlling for background factors and severity. Self‐choice (without pressures) correlated with a good outcome (a lower number of dependence criteria). Pressures were generally associated with poorer outcome. Alcohol misusers who had experienced threats regarding child custody did better in comparison with those not experiencing such pressure. The difference in results by drug type and implications were discussed.     

Unexpected Caregiving in Later Life: Illuminating the Narratives of Resilience of Grandmothers and Relative Caregivers through Photovoice Methodology

ABSTRACT

This research study implements photovoice methodology with unexpected caregivers to illuminate the lived experiences of female grandparents and relative caregivers who are raising young children in the later stages of their life. As they enter older adulthood, grandmothers are increasingly finding themselves taking care of their children’s children for various reasons, including, but not limited to, their adult child’s incarceration, mental health issues, drug and alcohol addiction, or child abuse or neglect. Informed by various feminist theoretical lenses, we use photovoice methodology to highlight the narratives of resilience and explore the ways in which grandmothers re-conceptualize their roles and identity as an unexpected caregiver and the sources of strength and resilience that inform the ways in which they navigate the various circumstances in their lives.     

Contexts of Mother–Child Separations in Homeless Families

Families that contend with the losses, disruptions, and hardships occasioned by homelessness often experience dispersal of children as well. Although a federal initiative on homeless families identified family preservation as a focus of intervention development, there is little research to guide service efforts. This qualitative study of mother–child separations in homeless families with maternal mental health and/or substance use problems identifies precursors of separations (precarious housing, turbulent relationships, substance abuse by mothers and others, institutional confinement, and children's needs) and examines how mothers' responses to these events and conditions interact with social and institutional contexts to shape variations in the course and outcome of separations. Implications for research, services, and policies affecting homeless families are discussed.     

Abstracts of theses: July, 1952 Smith college School for social work

Abstract

This article examines models of addiction and heroin treatment outcomes as well as the history of xenophobia, racial scapegoating, and misinformation in the promotion of narcotics prohibition in the United States. The moral model of addiction holds that punishment of the addict will be effective deterrence, yet punishment has not prevented heroin use, and narcotics control costs continue to spiral. The medical model of addiction, the dominant philosophical underpinning for current treatment methods, is shown to lack scientific corrobora‐tion and therefore to be inappropriate as a basis for policy on heroin use and inadequate to govern options in heroin addiction treatment. The discouraging outcomes of all modes of heroin addiction treatment indicate that treatment will not end the demand for the drug. Gradual legalization of heroin, while instituting formal and informal social structures geared to controlled use, is recommended.     

Childhood maltreatment among Norwegian drug abusers in treatment

This article reports on the investigation of the correlation between the European Addiction Severity Index (EuropASI) and the Childhood Trauma Questionnaire (CTQ) among 102 Norwegian drug abusers admitted to treatment. The aim of the study is to explore how different types and levels of childhood trauma and social and psychiatric factors, medical situation and experienced family history are interrelated. The study addresses three main questions: 1) What is the prevalence of different kinds of childhood trauma among drug abusers in treatment? 2) Does type or level of maltreatment in childhood predict specific substance abuse problems as adults and/or specific social, psychiatric and medical problems as adults? 3) Do substance abuse problems and mental health problems in the primary family predict different types and levels of childhood maltreatment? Twenty‐five per cent of the total sample was included in the high‐level trauma group and 54% in the intermediate‐level group. Females had significantly higher scores than males in all types of childhood trauma. The strongest correlations were found between childhood trauma and lifetime psychiatric problems and psychiatric status during the last 30 days before admission for treatment. More research, and especially prospective studies, is needed to clarify the importance of parents' substance abuse and psychiatric problems in childhood/adolescent compared with trauma in the client's childhood and the client's current psychiatric status.     

Substance misuse stories among Pacific peoples in New Zealand

This paper examines the oral stories of Pacific people attending addiction treatment services in Auckland, New Zealand who were participating in a larger study exploring the validity of the Alcohol, Smoking and Substance Involvement Screening Test. (ASSIST). A Talanoa approach was used by interviewers to help gain an understanding of the factors associated with participants’ substance misuse. Interviewers made notes of the stories they heard. Fifty participants were interviewed and expressed concerns related to how their substance use was influenced by their peers (66%, n?=?33), the environment they were living in (60%, n?=?30), and their family (50%, n?=?25). Sixteen participants provided detailed narratives of their lived experiences that permitted further in-depth analysis. Thematic analysis of these narratives revealed five interrelated themes; introduction to drugs and alcohol, family dynamics access to drugs, attempts at giving up, and motivation to stop. The use of a Talanoa approach, whilst administering a screening tool, such as the ASSIST, allows for a more in-depth exploration of an individual’s substance use. The information gathered would allow those working with Pacific people who misuse alcohol and/or drugs to develop culturally appropriate interventions.     

Secure Attachment to Family and Community

ABSTRACT

Disproportionately large numbers of high risk clients from Multiple Problem Families (MPFs) utilize a disproportionately large percentage of Medicaid, Health and Human Services. Clients from these families are involved in domestic violence, addiction, child abuse and neglect. They are over represented on the caseloads of state protective service agencies. The approach outlined in this paper is based on social attachment theory models. It stresses the use of long-term, home-based therapy, and community support agencies to establish and maintain safe secure attachment for these fragile families. The therapeutic goals are to foster attachments that lead to increased mentalisation, and to decrease the crisis-driven behavior that often results in high cost utilization of state services. A placement prevention model, outlined as an alternative “mentalising social system” approach, is proposed for treating disruptive MPF children. Family oriented, in-home, community-based treatment is found to be more cost effective and therapeutically helpful for these children than costly inpatient psychiatric admission followed by residential care.     

Use of Self-Disclosure for the Gay Male Therapist: The Impact on Gay Males in Therapy

ABSTRACT

Homophobia and heterosexism often can negatively affect a gay male's development, and developing internalized homophobia can challenge connecting with others. Using a sample of eight therapist–patient pairs (16 participants), each participant responded to how often the therapist self-disclosed. In addition, each participant completed a measurement inventory to determine how connected each was to the other (patient to therapist or therapist to patient). Findings indicated that self-disclosure occurred often during therapy, and there was a fairly high level of connection between patients and therapists. Patients who perceived that their therapists self-disclosed more often also reported higher levels of connection when compared with those who perceived a lower level of therapist self-disclosure. Recommendations for future research are made along with practice implications designed to help therapists effectively use self-disclosure when working with gay male clients.     

Criteria for Admission to Detoxification Treatment

This paper examines the formal triage process used by an alcohol/drug detoxification center to determine a client's need for treatment. The analysis tests various types of client characteristics for their influence on admission decisions. In accord with the policy of the agency and the medical model of addiction, symptoms of acute physiological withdrawal should determine whether a client is admitted for treatment during the triage period. Societal reaction theory presents an alternative perspective suggesting that a person's history of substance abuse and socio-demographic characteristics will influence the likelihood of admission into a treatment program. Results offer support for both a medical model and societal reaction approach in that physiological withdrawal symptoms, history of abuse characteristics, and socio-demographic makeup each independently influence staff's assessment of the need for treatment.     

Introducing audio-vision into evidence: the impact of audio recordings and their technical limitations in police use of force cases

ABSTRACT

This article explores the technical limitations of audio recordings and how those limitations impact the reliability of sound evidence in police use of force cases. In audiovisual recordings, audio is often assumed neutral, redundant or to have the same limitations as its visual counterpart. Bringing together film theorist Michel Chion’s concept of audio-vision and the technical specifications of mobile audio recording, this article highlights how design priorities and compression processes can influence the way sound evidence is perceived. By failing to acknowledge audio recordings as distinct from their visual counterparts, they are rendered invisible and are therefore under scrutinized throughout legal processes. This neglect becomes notably problematic in cases of police use of force where audio/visual recordings often work to bolster the already privileged officer testimony.